Provider Demographics
NPI:1225210040
Name:SCHOOL DISTRICT OF CLAYTON
Entity Type:Organization
Organization Name:SCHOOL DISTRICT OF CLAYTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIMON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-948-2165
Mailing Address - Street 1:221 S PRENTICE ST
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:WI
Mailing Address - Zip Code:54004-9113
Mailing Address - Country:US
Mailing Address - Phone:715-948-2165
Mailing Address - Fax:
Practice Address - Street 1:221 S PRENTICE ST
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:WI
Practice Address - Zip Code:54004-9113
Practice Address - Country:US
Practice Address - Phone:715-948-2165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI44235500Medicaid